The Call-In: Your Stories About Veterans Affairs

And this is the Call-In. Today we're talking about veterans' health care. In recent years, the VA has developed a reputation for red tape, long wait times and lapses in care. So we asked you to share your stories about getting the care you need from the VA.

GARCIA-NAVARRO: I want to start with a pretty simple question. How many people get their care through the VA, and what determines how people qualify?

LAWRENCE: Sure. There are about 20 million vets in the United States, most of them from earlier eras - World War II, Vietnam - when there was a draft. About 9 million of them are enrolled in VA health care. About 6 million of those are sort of regular yearly users of VA health care.

GARCIA-NAVARRO: That's a huge system.

LAWRENCE: Yeah it is. It's the largest single-payer system in the country. Most vets can qualify for it if they have a service-connected injury. If they are five years after having served in the recent wars, they can make it. There's also an income threshold. So the VA more or less says if you're a vet, you should apply, and we'll let you know if you're eligible, but most - many vets are.

GARCIA-NAVARRO: All right, I want to have you listen to some of the calls that we got. We got a ton of messages like this one from Joyce Davenport (ph) of Ocklawaha, Fla. Let's listen.

JOYCE DAVENPORT: I have been a patient of the VA since my discharge back in the 70s, and I have had only wonderful experiences with them. They have gotten me through some very rough times. I've received 100 percent of my medical care from them, and I cannot tell you how much I appreciate them being there.

GARCIA-NAVARRO: I should say the vast majority of the people who called in were really happy with their VA care. Are vets mostly satisfied?

LAWRENCE: Yeah. And I can hear the surprise in your voice. And that's, I suppose, partly due to the fact that negative headlines are what really run the media. So...

GARCIA-NAVARRO: No.

LAWRENCE: (Laughter) Yes, it's true. I'm not surprised by that at all. Even people who are having problems say the bureaucracy of getting their care or getting a disability rating, getting things - sort of getting in the door - they will say, well, but my doc at the VA is wonderful. So VA, in studies, rates as good or better than in the private sector in most areas of health care. Although, the question really is, compared to what? What care would this veteran be getting in the private sector if the VA wasn't there?

GARCIA-NAVARRO: OK, we're going to come to that in a minute. But first, you mentioned something, which is that the VA has gotten a lot of negative press - long wait times, shortages of doctors, and we got calls about that, too. Listen.

MARK COYUS: My name is Mark Coyus (ph), and I am a Marine Corps veteran calling from Denver, Colo. I think that the VA is overworked, understaffed and underpaid. With the state of the world and how much our veterans sacrifice for us with so little in return, the status quo is unacceptable for both them and VA caregivers.

GARCIA-NAVARRO: OK, so what have been the biggest problems?

LAWRENCE: The VA is a massive bureaucracy. It's got 360,000 employees. They literally invented the term red tape at VA, and there were horrible backlogs when a lot of recent vets were coming home from Iraq and Afghanistan. In 2014, a scandal kind of came to a head about senior managers who had been lying about their statistics - about how fast they were seeing veterans. And there were some somewhat misleading headlines about veterans who were dying while they were waiting for care. And that brought about calls for reform, which were quite genuine but also somewhat politically motivated, where VA health care, which is the largest example of government-run health care in the country, became kind of a proxy battle for people in Congress who love the idea of government health care against people who hate the idea of government-run health care.

GARCIA-NAVARRO: There's been a lot of effort made to improve veterans' care, and this is a bipartisan issue. Congress passed legislation a few years ago to make it easier for veterans to access that private care. Can you bring us up to speed on this? What does it mean for the VA system?

LAWRENCE: So again, in response to this scandal in 2014, Congress passed a law called the Veterans' Choice Act. They wanted to get something set up quick but, as a result, it's been a real mixed bag. It was a system so that veterans, if they had been waiting too long or if they lived too far from a VA, they could just go out to a private doctor get their care, and the VA would pay for it. The result in many cases was just another maddening layer of red tape.

Sometimes it took longer to get an appointment in the private sector than it would have originally at the VA. But the VA's always done some referrals for private care. This month, President Trump signed an order extending the Veterans' Choice program just as kind of a stopgap because it was about to expire in August. But we're expecting Congress and the VA to work on a way to streamline this process. And they say they're going to pass that sometime in the fall.

GARCIA-NAVARRO: I want to play you this message we got from Anna Smith (ph) who's worried about the VA's future.

ANNA SMITH: I fear that some changes that people are proposing, such as privatizing parts of it and that sort of thing, is just going to ruin a good deal for those of us who are lucky enough to be able to use the services of the VA.

GARCIA-NAVARRO: So you've talked about this political football of people pro and against sort of socialized medicine, if you will. What kind of support is there for privatization?

LAWRENCE: So no one will say they want privatization. All of the veterans organizations say that they're against it. The new secretary of the VA, Dr. David Shulkin, says he's against privatization. Now, that doesn't stop some people from claiming that there is sort of a Trojan horse here, where this Veterans' Choice program of allowing vets to go into the private sector is an attempt to bleed resources away from the VA into private care, which is much more expensive, and that would sap the VA's resources and make the care even worse and lead to this sort of spiral.

The VA is supposed to be this sort of holy vow to take care of veterans. Abraham Lincoln said that it was created for those who have borne the battle and their widow and their orphan. On the other side are people who say, well, the VA can be a lot leaner with strategic use of the private sector in remote places - in places where there's too much demand on their clinics. This is a battle that we're going to see continue to play itself out with a lot of people who sincerely studied VA health care and then a lot of people who have a political agenda, as well.

GARCIA-NAVARRO: And next week on the Call-In, we want to hear your stories and questions about airline travel. How has flying been recently? Do you have any tips or tricks for navigating airlines and airports? If you work for an airline, tell us about your job. What questions do you have about the airline industry and where it's headed? Call in at 202-216-9217. Leave us a voicemail with your full name, where you're from, and your experience, and we may use it on the air. That number again - 202-216-9217. Transcript provided by NPR, Copyright NPR.

As promised, President Trump has moved to dismantle the Affordable Care Act. It's a concern for those who might be left without health insurance — and especially for the Department of Veterans Affairs, which may have to pick up some of the slack.

Carrie Farmer, a health policy researcher at the Rand Corp., says 3 million vets who are enrolled in the VA usually get their health care elsewhere — from their employer, or maybe from Obamacare exchanges. If those options go away, she has no idea just how many of those 3 million veterans will move over to the VA.